Antineoplastics Amphotericin

An additive nephrotoxicity develops when pentamidine isethionate is administered with other nephrotoxic drugs (eg, aminoglycosides, vancomycin, or amphotericin B). An additive bone marrow depression occurs when the drug is administered with antineoplastic drugs or when the patient lias received radiation therapy recently. 

Flucytosine (5-FC) was discovered in 1957 during a search for novel antineoplastic agents. Though devoid of anticancer properties, it became apparent that it was a potent antifungal agent. Flucytosine is a water-soluble pyrimidine analog related to the chemotherapeutic agent fluorouracil (5-FU). Its spectrum of action is much narrower than that of amphotericin B. 

Gallium Nitrate (Ganite) [Hormone] Uses T Ca2+ of malignancy bladder CA Action X- bone resorption of Ca2+ Dose T Ca2+ 200 mg/m2/d x 5 d CA 350 mg/m2 cont inf X 5 d to 700 mg/m2 rapid IV inf q2wk in antineoplastic settings (per protocols) Caution [C, ] Do not give w/ live or rotavirus vaccine Contra SCr >2.5 mg/dL Disp Inj SE Renal insuff, X- Ca2+, hypophosphatemia, X- bicarb, <1% acute optic neuritis Interactions T Risks of nephrotox W/ amphotericin B,... 

Amsacrine Amsacrine is incompatible with sodium chloride mixtures and glucose-containing injections with acyclovir sodium, ganciclovir sodium, aztreonam, amphotericin, cimetidine hydrochloride, ceftazidime, frusemide, ceftriaxone sodium, heparin sodium, methylprednisolone sodium succinate, metoclopramide hydrochloride, and some antineoplastics.204 Asparaginase is incompatible with many drugs and rubber, and should be stored at 2° to 8 °C for stability. 

Use of conventional amphotericin B with nephrotoxic antineoplastics such as cisplatin and ifosfamide may increase the risk of renal impairment, and should generally be avoided. Liposomal amphotericin B may be an alternative, but renal function should still be closely monitored. 

The manufacturer of conventional amphotericin B states that nephrotoxic antineoplastics should not be given concurrently except with great caution. Of the antineoplastics, cisplatin, ifosfamide and methotrexate are well known for their nephrotoxicity. Amphotericin also reduces the renal clearance of methotrexate , (p.642). 

Liposomal amphotericin B is licensed for use in the empirical treatment of presumed fungal infections in febrile neutropenic patients. It is therefore likely to be used in patients who have received antineoplastics and who may have antineoplastic-induced renal impairment. The manufacturer notes that it has been used successfully in a large number of patients with pre-existing renal impairment. Nevertheless, renal funetion should be elosely monitored in these patients. ... 

DaunoXome , used in treatment of Kaposi s sarcoma, is an example of a liposomal antineoplastic medicine. Daunorubicin hydrochloride (1 mg/mL) is encapsulated in small liposomes. Amphotericin B, which is used in the treatment of systemic fungal infection, is also formulated as a stable colloidal particle. 

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